Efficacy of topical hemostatic agents in malignancy-related gastrointestinal bleeding: a systematic review and meta-analysis

Internal Medicine, Allegheny Health Network, Pittsburgh, US. Internal Medicine, Hurley Medical Center, Two Hurley Plaza, Michigan State University, Flint, MI, US. Foundation Fellowship Doctor, University Hospital, Southampton NHS Foundation Trust, Southampton, Hampshire, UK. Gastroenterology & Hepatology, University of Utah Health School of Medicine, Salt Lake City, UT, US. Internal medicine, Mayo College of Medicine, Rochester, Minnesota, US. Endoscopy Unit, Sorbonne University, AP-HP, Saint-Antoine Hospital, 75012 Paris, France. Gastroenterology department, UPEC University, AP-HP, Henri Mondor Hospital, 94010 Creteil, France. Division of Gastroenterology and Hepatology, Allegheny Health Network, Pittsburgh, US. Center for Advanced Therapeutic Endoscopy, Centura Health, Denver, CO, US. Electronic address: dougraham2001@gmail.com.

Gastrointestinal endoscopy. 2022

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BACKGROUND AND AIMS Despite advances in endoscopic therapies, malignancy-related gastrointestinal (GI) bleeding remains difficult to manage with high rates of treatment failure and rebleeding. Topical hemostatic agents (THA) are easier to apply to the wide bleeding surface of tumors. We conducted this systematic review and meta-analysis to evaluate the efficacy of THAs in malignancy-related GI bleed. METHODS We conducted a comprehensive search of multiple electronic databases to identify studies reporting on the use of THAs in malignancy-related GI bleeding. The primary outcome was the achievement of hemostasis; secondary outcomes were early rebleeding (≤ 3 days), delayed rebleeding (>3 days), aggregate rebleeding, all-cause mortality, and GI bleed related mortality. A meta-analysis of proportions was done for all outcomes. RESULTS Out of 355 citations, total 16 studies with 530 patients were included. Primary hemostasis was achieved in 94.1% (95% CI: 91.5 - 96.0%). Early rebleeding was seen in 13.9% (95% CI: 9.7 - 19.4%) while delayed rebleeding was seen in 11.4% (95% CI: 5.8 - 21.1%). Aggregate rebleeding was seen in 24.2% (95% CI:18.5 - 31.0%). All-cause mortality was 33.1% (95% CI: 23.7 - 44.0%) while GI bleed related mortality occurred in 5.9% (95% CI: 2.2% - 14.8%). CONCLUSIONS THAs are highly effective for achieving primary hemostasis in malignancy-related GI bleeding. It should be considered as an alternative to traditional endotherapy methods in malignancy-related GI bleeds. Future studies should be designed to evaluate its efficacy and safety as a primary method of hemostasis as compared to traditional endotherapy measures.
Study details
Study Design : Systematic Review
Language : eng
Credits : Bibliographic data from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine